Extra luminal scaffold

ABSTRACT

Methods and devices for treating a luminal pathology affecting an anatomical lumen of a patient comprising forming, in situ, a continuous cohesive layer of covalently-crosslinked hydrogel in a luminal wall of the anatomical lumen.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/520,877 filed Apr. 21, 2017, which claims priority to PCT ApplicationNo. PCT/US2015/057091 filed Oct. 23, 2015, and U.S. ProvisionalApplication No. 62/068,351 filed Oct. 24, 2014, all of which are herebyincorporated herein by reference.

TECHNICAL FIELD

The technical field is related to bioeffective drugs and compositionsfor treating the body, and includes surgical tools and pharmaceuticallyacceptable implant systems comprising hydrogels that support the wall ofan anatomical cavity or deliver a drug to the wall of an anatomicalcavity.

BACKGROUND

Implants that deliver drugs over time in a therapeutically effectivedosage are useful in many fields. The science of controlled drug releaseis diverse from a standpoint of both range of scientific disciplines itencompasses and the range of its applications.

SUMMARY

Hydrogels can be delivered into the endoluminal wall. The hydrogels canbe formed from hydrogel precursors that crosslink with each other insitu in the endoluminal wall. Described herein are various medicaldevices and methods, including injecting a hydrogel or liquid hydrogelprecursors into the wall of an anatomical cavity (vessels or otherhollow organs) to form a gel-based support matrix as an Extra-luminalScaffold or an Endomural Stent.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a longitudinal cross-sectional view of an anatomical lumen,and shows a site of introduction at an adventitia;

FIG. 1B is a transverse cross-sectional view of the lumen of FIG. 1A;

FIG. 2A depicts a hydrogel introduced at the site of FIG. 1, with anagent, at an adventitia;

FIG. 2B is a transverse cross-sectional view of the lumen of FIG. 2Ataken along line BB;

FIG. 3A is a longitudinal cross-sectional view of an anatomical lumenthat shows a liquid/gel delivery into a luminal wall;

FIG. 3B is a transverse cross-sectional view of the lumen of FIG. 3Ataken along line BB;

FIG. 3C is a perspective view of the device used in FIG. 3A,

FIG. 4A is a longitudinal cross-sectional view of an anatomical lumenthat shows a liquid/gel delivery into a luminal wall;

FIG. 4B is a transverse cross-sectional view of the lumen of FIG. 4Ataken along line BB;

FIG. 4C is a perspective view of the device used in FIG. 4A,

FIG. 5A is a longitudinal cross-sectional view of an anatomical lumenthat shows a liquid/gel delivery into a luminal wall;

FIG. 5B is a transverse cross-sectional view of the lumen of FIG. 5Ataken along line BB;

FIG. 6A is a cut-away view of an anatomical lumen that shows aliquid/gel delivery from a helical hypowall into a luminal wall;

FIG. 6B is a perspective view of the device used in FIG. 6A; and

FIG. 7 is a partial cross sectional view of a device comprising a curvedneedle and a pushing mandrel for delivering an injectable paste into aluminal wall.

DETAILED DESCRIPTION

Described herein are a number of devices and methods of forming ahydrogel in a tissue, including natural or artificial potential spaces,a wall of an anatomical cavity (vessels or other hollow organs), and awall of a blood vessel. The hydrogel may be used to provide a stentingaction and/or to maintain patency of a body lumen. The hydrogel may holda lumen of the vessel, organ, or space open without causing flowrestrictions, unacceptable inflammation, undue disruption of the lumenor tearing of the tissue. Embodiments include, for instance, forming agel-based support matrix as an extra-luminal scaffold or an endomuralstent. The hydrogels may also be used to deliver a therapeutic agent(such as an active pharmaceutical ingredient (API)) at the luminal wall,media, adventitia, or surrounding tissues with the shortest path ofdiffusion from the suspension into the luminal wall and/or othersurrounding tissues. Hydrogel formulations can be tailored using factorssuch as: persistence of the hydrogel after implantation by controlling ahydrolysis-driven degradation rate; crosslinking conditions tofacilitate control of the hydrogel distribution and shape as itcrosslinks in situ following injection; and mechanical properties of thecrosslinked material, such as modulus, hydrophilicity, strength, andcohesiveness.

Suspending the agent in a hydrogel can allow the agent to persist and bebioavailable for a longer duration in the luminal wall than an aqueoussolution or suspension. Longer persistence of therapeutic levels of theagent reduces the frequency that the agent needs to be readministered. Ahydrogel reduces the agent washout that may occur with aqueous solutionsand suspensions as well. Moreover, the agent can be disposed in variousforms inside the hyrdrogel—in particles, in control-release particles(e.g., liposomes, micelles, capsules), as a solid, as an insoluble drug,and so forth. One such embodiment is to dispose the drug insideparticles made of another hydrogel, with the various forms of the agentbeing options for disposition in one or both of the hydrogels. Further,a non-fluent hydrogel can help to seal at the site of its introduction.

One of the challenges in this field is that the hydrogel is preferably auniform material with a shape suited for delivery of the agent. Auniform material provides for consistent and controllable results. Asingle cohesive mass of material creates a three-dimensional spacehaving a geometry suited to certain kinds of controlled release of theagent. Certain kinds of controlled release schemes are enabled when acohesive mass is created. Alternatively, merely scattering particlescontaining an agent a short distance from their site of introduction atthe luminal wall or other space provides a different delivery condition.Placement of the hydrogel between the layers of the luminal wallpresents enhanced opportunities for controlled release including rapiddrug diffusion into the endomural space or sustained delivery of thedrug(s) over time using a permanent or resorbable endomural stentstructure. Placement of the hydrogel between the layers of the luminalwall also allows for a permanent endomural stent construction, apermanent endomural structure, or a resorbable endomural stent structureto mechanically prop the lumen open and maintain such opening.Precursors that are cohesive at the pre-crosslinking stage may bechosen, as well as precursors that form cross-links with each other.

FIG. 1 depicts a site of injection in an anatomical lumen. By way ofoverview, blood vessel 10 has lumen 12 surrounded by a layer ofendothelial cells 14 that is surrounded by media 16 that is surroundedby adventitia 18. A site 19 receives an injection or other introductionof a hydrogel or hydrogel precursors. The hydrogel or hydrogelprecursors flow from the site (or sites) into the wall of the bloodvessel. FIG. 2 shows cohesive hydrogel layer 20 at an adventitia-medialocation. Hydrogel precursors, drug loaded hydrogel particles, ordrug-containing dried pastes may be injected into the luminal wall.These methods create an area of contact within the luminal wall. An areaof contact could be, e.g., from 0.1 to 60 mm²; artisans will immediatelyappreciate that all ranges and values within this range are contemplatedand supported, e.g., 1, 2, 5, 6, or 8 mm². A height, consideredindependently or in addition to an area of contact may be, e.g., 10 μmto 5 mm.

In general, to form a hydrogel, one or more precursors are reacted. Theprecursors form crosslinks that prevent the dissolution of the hydrogelin water. Precursors may be crosslinked via an ionic or covalent bond, aphysical force, or other attraction. A covalent crosslink, however, willtypically offer stability and predictability in reactant productarchitecture. To form covalently crosslinked hydrogels, the precursorsare covalently crosslinked together. In general, precursors are joinedto other precursors at two or more points, with each point being alinkage to the same or different polymers. Precursors with at least tworeactive centers (for example, in free radical polymerization) can serveas crosslinkers since each reactive group can participate in theformation of a different growing polymer chain. In the case offunctional groups without a reactive center, among others, crosslinkingrequires three or more such functional groups on at least one of theprecursor types. For instance, many electrophilic-nucleophilic reactionsconsume the electrophilic and nucleophilic functional groups so that athird functional group is needed for the precursor to form a crosslink.Such precursors thus may have three or more functional groups and may becrosslinked by precursors with two or more functional groups. These aredescribed in some detail, below.

The precursors may be injected or otherwise introduced into a luminalwall area, where they will form a hydrogel. The precursors may be chosento have a delayed time of crosslinking to provide for flow of theprecursors in and around the site of initial introduction. The hydrogelmay be prepared as a paste. The precursors of the hydrogel may be apaste and form crosslinks inside the wall. Or a hydrogel may be preparedas a collection of hydrogel particles that are prepared as a fluentpaste. The paste of precursors and/or paste of hydrogel may be forcedinto the luminal wall. A paste is a viscous fluid that will flow only inresponse to a force applied to it. Moreover, the paste may be preparedas a gel that is not crosslinked before or after placement. Forinstance, the paste may comprise a gel comprising polymers, e.g.,thermoresponsive polymers such as PLURONIC F127 gels or polysaccharidepreparations, e.g., hyaluronic acid.

Devices

FIGS. 3-7 depict some embodiments of devices and methods for injectingmaterials at in a luminal wall or other location. Alternatively,conventional techniques for placement of a material at a luminal wallmay be used.

FIG. 3 demonstrates medical balloon 30 with one or more holes 32 orother predetermined openings to build enough pressure during injectionof fluent precursors, in order for the balloon to fill the target hollowluminal space, get approximated to the luminal wall, and drive theprecursors with adequate hydraulics into the luminal wall, media,adventitia or surrounding tissues.

FIG. 4 demonstrates a balloon 40 lined with one or more flexible hollowtubes 42 with one or more holes 44 with predetermined openings. In thisembodiment the balloon is inflated at a desired pressure to expand andfill the hollow intraluminal space and drive the delivery tube(s) 42against the endoluminal wall. Next, the fluent precursors are injectedindependently through the delivery tubes endomurally into the luminalwall, media, adventitia or surrounding tissues.

FIG. 5 demonstrates a balloon system 50 integrated with one or moreneedles 52 of predetermined size to build enough pressure duringinjection of the fluent precursors for balloon 50 to fill the targethollow luminal space, drive needle(s) 52 into the luminal wall, anddrive the precursors with adequate hydraulics endomurally into theluminal wall, media, adventitia or surrounding tissues. Examples ofmicro needles can be found in U.S. Pat. No. 8,740,849 to Fischell etal., U.S. Pat. No. 8,465,752 to Seward, U.S. Pat. No. 8,721,590 toSeward et al., and U.S. Pat. No. 7,141,041 to Seward, which are herebyincorporated by reference herein in their entirety to the extent they donot contradict what is explicitly disclosed herein.

FIG. 6 demonstrates a non-balloon-based system of hypotube(s) 60 whichmay be oriented in a helical fashion or in a weaved or woven style, tobe mechanically expandable through some form of mechanical actuation.The actuation causes hypotube(s) 60 to expand in the targeted space, andcertain holes/openings created in the expandable part of the hypotubes,whereby such expandable region is approximated to the luminal wall, andallow for the pre-polymers to be injected into the luminal wall, media,adventitia or surrounding tissues with adequate hydraulics. Holes 62 areforced against the walls of lumen 12 when tubes 6 are expanded.

FIG. 7 demonstrates a needle system 70 for injecting an injectable paste72. In this embodiment, a nitinol or other flexible needle 74 that bendsas it is advanced from a sheath is inserted into the luminal wall. Theneedle 74 is preloaded with a drug containing dried paste 72, forexample using a polyethylene glycol hydrogel base. A pushing mandrel 76is then advanced once the needle is positioned, pushing the paste intothe perivascular space. The mandrel tip 78 may be very flexible (forexample, a spring), to avoid altering the shape of the needle as it isadvanced.

Precursor Materials

The hydrogels are made from precursors. Precursors are chosen inconsideration of the properties that are desired for the resultanthydrogel. There are various suitable precursors for use in making thehydrogels. The term precursor refers to those molecules crosslinked toform the hydrogel or organogel matrix. While other materials might bepresent in the hydrogel or organogel, such as therapeutic agents orfillers, they are not precursors. Hydrogels are materials that do notdissolve in water and retain a significant fraction (more than 20%) ofwater within their structure. In fact, water contents in excess of 90%are often known. Hydrogels may be formed by crosslinking water solublemolecules to form networks of essentially infinite molecular weight.Hydrogels with high water contents are typically soft, pliablematerials. Hydrogels and drug delivery systems as described in U.S.Publication Nos. 2009/0017097, 2011/0142936 and 2012/0071865 may beadapted for use with the materials and methods herein by following theguidance provided herein; these references are hereby incorporatedherein by reference for all purposes, and in case of conflict, theinstant specification is controlling.

Hydrogels may be formed from natural, synthetic, or biosyntheticpolymers. Natural polymers may include glycosminoglycans,polysaccharides, and proteins. Some examples of glycosaminoglycansinclude dermatan sulfate, hyaluronic acid, the chondroitin sulfates,chitin, heparin, keratin sulfate, keratosulfate, and derivativesthereof. In general, the glycosaminoglycans are extracted from a naturalsource and purified and derivitized. However, they also may besynthetically produced or synthesized by modified microorganisms such asbacteria. These materials may be modified synthetically from a naturallysoluble state to a partially soluble or water swellable or hydrogelstate. This modification may be accomplished by various well-knowntechniques, such as by conjugation or replacement of ionizable orhydrogen bondable functional groups such as carboxyl and/or hydroxyl oramine groups with other more hydrophobic groups.

For example, carboxyl groups on hyaluronic acid may be esterified byalcohols to decrease the solubility of the hyaluronic acid. Suchprocesses are used by various manufacturers of hyaluronic acid products(such as Genzyme Corp., Cambridge, Mass.) to create hyaluronic acidbased sheets, fibers, and fabrics that form hydrogels. Other naturalpolysaccharides, such as carboxymethyl cellulose or oxidized regeneratedcellulose, natural gum, agar, agrose, sodium alginate, carrageenan,fucoidan, furcellaran, laminaran, hypnea, eucheuma, gum arabic, gumghatti, gum karaya, gum tragacanth, locust beam gum, arbinoglactan,pectin, amylopectin, gelatin, hydrophilic colloids such as carboxymethylcellulose gum or alginate gum crosslinked with a polyol such aspropylene glycol, and the like, also form hydrogels upon contact withaqueous surroundings.

Synthetic hydrogels may be biostable or biodegradable. Examples ofbiostable hydrophilic polymeric materials are poly(hydroxyalkylmethacrylate), poly(electrolyte complexes), poly(vinylacetate)cross-linked with hydrolysable or otherwise degradable bonds, andwater-swellable N-vinyl lactams. Other hydrogels include hydrophilichydrogels known as CARBOPOL®, an acidic carboxy polymer (Carbomer resinsare high molecular weight, allylpentaerythritol-crosslinked, acrylicacid-based polymers, modified with C10-C30 alkyl acrylates),polyacrylamides, polyacrylic acid, starch graft copolymers, acrylatepolymer, ester cross-linked polyglucan. Such hydrogels are described,for example, in U.S. Pat. No. 3,640,741 to Etes, U.S. Pat. No. 3,865,108to Hartop, U.S. Pat. No. 3,992,562 to Denzinger et al., U.S. Pat. No.4,002,173 to Manning et al., U.S. Pat. No. 4,014,335 to Arnold and U.S.Pat. No. 4,207,893 to Michaels, all of which are incorporated herein byreference, with the present specification controlling in case ofconflict.

Hydrogels may be made from precursors. The precursors are crosslinkedwith each other. Crosslinks can be formed by covalent bonds or physicalbonds. Examples of physical bonds are ionic bonds, hydrophobicassociation of precursor molecule segments, and crystallization ofprecursor molecule segments. The precursors can be triggered to react toform a crosslinked hydrogel. The precursors can be polymerizable andinclude crosslinkers that are often, but not always, polymerizableprecursors. Polymerizable precursors are thus precursors that havefunctional groups that react with each other to form matrices and/orpolymers made of repeating units. Precursors may be polymers.

Some precursors thus react by chain-growth polymerization, also referredto as addition polymerization, and involve the linking together ofmonomers incorporating double or triple chemical bonds. Theseunsaturated monomers have extra internal bonds which are able to breakand link up with other monomers to form the repeating chain. Monomersare polymerizable molecules with at least one group that reacts withother groups to form a polymer. A macromonomer (or macromer) is apolymer or oligomer that has at least one reactive group, often at theend, which enables it to act as a monomer; each macromonomer molecule isattached to the polymer by reaction the reactive group. Thusmacromonomers with two or more monomers or other functional groups tendto form covalent crosslinks. Addition polymerization is involved in themanufacture of, e.g., polypropylene or polyvinyl chloride. One type ofaddition polymerization is living polymerization.

Some precursors thus react by condensation polymerization that occurswhen monomers bond together through condensation reactions. Typicallythese reactions can be achieved through reacting molecules incorporatingalcohol, amine or carboxylic acid (or other carboxyl derivative)functional groups. When an amine reacts with a carboxylic acid an amideor peptide bond is formed, with the release of water. Some condensationreactions follow a nucleophilic acyl substitution, e.g., as in U.S. Pat.No. 6,958,212, which is hereby incorporated by reference herein in itsentirety to the extent it does not contradict what is explicitlydisclosed herein. Some precursors react by a chain growth mechanism.Chain growth polymers are defined as polymers formed by the reaction ofmonomers or macromonomers with a reactive center. A reactive center is aparticular location within a chemical compound that is the initiator ofa reaction in which the chemical is involved. In chain-growth polymerchemistry, this is also the point of propagation for a growing chain.The reactive center is commonly radical, anionic, or cationic in nature,but can also take other forms. Chain growth systems include free radicalpolymerization, which involves a process of initiation, propagation andtermination. Initiation is the creation of free radicals necessary forpropagation, as created from radical initiators, e.g., organic peroxidemolecules. Termination occurs when a radical reacts in a way thatprevents further propagation. The most common method of termination isby coupling where two radical species react with each other forming asingle molecule. Some precursors react by a step growth mechanism, andare polymers formed by the stepwise reaction between functional groupsof monomers. Most step growth polymers are also classified ascondensation polymers, but not all step growth polymers releasecondensates. Monomers may be polymers or small molecules. A polymer is ahigh molecular weight molecule formed by combining many smallermolecules (monomers) in a regular pattern. Oligomers are polymers havingless than about 20 monomeric repeat units. A small molecule generallyrefers to a molecule that is less than about 2000 Daltons. Theprecursors may thus be small molecules, such as acrylic acid or vinylcaprolactam, larger molecules containing polymerizable groups, such asacrylate-capped polyethylene glycol (PEG-diacrylate), or other polymerscontaining ethylenically-unsaturated groups, such as those of U.S. Pat.No. 4,938,763 to Dunn et al., U.S. Pat. Nos. 5,100,992 and 4,826,945 toCohn et al., or U.S. Pat. Nos. 4,741,872 and 5,160,745 to DeLuca et al.,each of which is hereby incorporated by reference herein in its entiretyto the extent it does not contradict what is explicitly disclosedherein.

In some embodiments, each precursor is multifunctional, meaning that itcomprises two or more electrophilic or nucleophilic functional groups,such that a nucleophilic functional group on one precursor may reactwith an electrophilic functional group on another precursor to form acovalent bond. At least one of the precursors comprises more than twofunctional groups, so that, as a result of electrophilic-nucleophilicreactions, the precursors combine to form crosslinked polymericproducts.

The precursors may have biologically inert and hydrophilic portions,e.g., a core. In the case of a branched polymer, a core refers to acontiguous portion of a molecule joined to arms that extend from thecore, with the arms having a functional group, which is often at theterminus of the branch. A hydrophilic molecule, e.g., a precursor orprecursor portion, has a solubility of at least 1 g/100 mL in an aqueoussolution. A hydrophilic portion may be, for instance, a polyether, forexample, polyalkylene oxides such as polyethylene glycol (PEG),polyethylene oxide (PEO), polyethylene oxide-co-polypropylene oxide(PPO), co-polyethylene oxide block or random copolymers, and polyvinylalcohol (PVA), poly (vinyl pyrrolidinone) (PVP), poly (amino acids,dextran, or a protein. The precursors may have a polyalkylene glycolportion and may be polyethylene glycol based, with at least about 80% or90% by weight of the polymer comprising polyethylene oxide repeats. Thepolyethers and more particularly poly (oxyalkylenes) or poly (ethyleneglycol) or polyethylene glycol are generally hydrophilic. As iscustomary in these arts, the term PEG is used to refer to PEO with orwithout hydroxyl end groups.

A precursor may also be a macromolecule (or macromer), which is amolecule having a molecular weight in the range of a thousand to manymillions. The hydrogel or organogel however, may be made with at leastone of the precursors as a small molecule of about 1000 Da or less(alternatively: 2000 Da or less). The macromolecule, when reacted incombination with a small molecule (of about 1000 Da or less/200 Da orless), is preferably at least five to fifty times greater in molecularweight than the small molecule and is preferably less than about 60,000Da; artisans will immediately appreciate that all the ranges and valueswithin the explicitly stated ranges are contemplated. A more preferredrange is a macromolecule that is about seven to about thirty timesgreater in molecular weight than the crosslinker and a most preferredrange is about ten to twenty times difference in weight. Further, amacromolecular molecular weight of 5,000 to 50,000 is useful, as is amolecular weight of 7,000 to 40,000 or a molecular weight of 10,000 to20,000. There are certain advantage to having a small molecule, such asdiffusivity for completion of reactions.

Certain macromeric precursors are the crosslinkable, biodegradable,water-soluble macromers described in U.S. Pat. No. 5,410,016 to Hubbellet al, which is hereby incorporated herein by reference in its entiretyto the extent it does not contradict what is explicitly disclosed. Thesemacromers are characterized by having at least two polymerizable groups,separated by at least one degradable region.

Synthetic precursors may be used. Synthetic refers to a molecule notfound in nature or not normally found in a human. Some syntheticprecursors are free of amino acids or free of amino acid sequences thatoccur in nature. Some synthetic precursors are polypeptides that are notfound in nature or are not normally found in a human body, e.g., di-,tri-, or tetra-lysine. Some synthetic molecules have amino acid residuesbut only have one, two, or three that are contiguous, with the aminoacids or clusters thereof being separated by non-natural polymers orgroups. Polysaccharides or their derivatives are thus not synthetic.

Alternatively, natural proteins or polysaccharides may be adapted foruse with these methods, e.g., collagens, fibrin(ogen)s, albumins,alginates, hyaluronic acid, and heparins. These natural molecules mayfurther include chemical derivitization, e.g., synthetic polymerdecorations. The natural molecule may be crosslinked via its nativenucleophiles or after it is derivatized with functional groups, e.g., asin U.S. Pat. Nos. 5,304,595, 5,324,775, 6,371,975, and 7,129,210, eachof which is hereby incorporated by reference to the extent it does notcontradict what is explicitly disclosed herein. Natural refers to amolecule found in nature. Natural polymers, for example proteins orglycosaminoglycans, e.g., collagen, fibrinogen, albumin, and fibrin, maybe crosslinked using reactive precursor species with electrophilicfunctional groups. Natural polymers normally found in the body areproteolytically degraded by proteases present in the body. Such polymersmay be reacted via functional groups such as amines, thiols, orcarboxyls on their amino acids or derivitized to have activatablefunctional groups. While natural polymers may be used in hydrogels,their time to gelation and ultimate mechanical properties must becontrolled by appropriate introduction of additional functional groupsand selection of suitable reaction conditions, e.g., pH.

Precursors may be made with a hydrophobic portion provided that theresultant hydrogel retains the requisite amount of water, e.g., at leastabout 20%. In some cases, the precursor is nonetheless soluble in waterbecause it also has a hydrophilic portion. In other cases, the precursormakes dispersion in the water (a suspension) but is nonethelessreactable to from a crosslinked material. Some hydrophobic portions mayinclude a plurality of alkyls, polypropylenes, alkyl chains, or othergroups. Some precursors with hydrophobic portions are sold under thetrade names PLURONIC F68, PLURONIC F 127, JEFFAMINE, or TETRONIC. Ahydrophobic molecule or a hydrophobic portion of a copolymer or the likeis one that is sufficiently hydrophobic to cause the molecule (e.g.,polymer or copolymer) to aggregate to form micelles or microphasesinvolving the hydrophobic domains in an aqueous continuous phase or onethat, when tested by itself, is sufficiently hydrophobic to precipitatefrom, or otherwise change phase while within, an aqueous solution ofwater at pH from about 7 to about 7.5 at temperatures from about 30 toabout 50 degrees Centigrade.

Precursors may have, e.g., 2-100 arms, with each arm having a terminus,bearing in mind that some precursors may be dendrimers or other highlybranched materials. An arm on a hydrogel precursor refers to a linearchain of chemical groups that connect a crosslinkable functional groupto a polymer core. Some embodiments are precursors with between 3 and300 arms; artisans will immediately appreciate that all the ranges andvalues within the explicitly stated ranges are contemplated, e.g., 4 to16, 8 to 100, or at least 6 arms.

Thus hydrogels can be made, e.g., from a multi-armed precursor with afirst set of functional groups and a low molecular-weight precursorhaving a second set of functional groups. For example, a six-armed oreight-armed precursor may have hydrophilic arms, e.g., polyethyleneglycol, terminated with primary amines, with the molecular weight of thearms being about 1,000 to about 40,000; artisans will immediatelyappreciate that all ranges and values within the explicitly statedbounds are contemplated. Such precursors may be mixed with relativelysmaller precursors, for example, molecules with a molecular weight ofbetween about 100 and about 5000, or no more than about 800, 1000, 2000,or 5000 having at least about three functional groups, or between about3 to about 16 functional groups; ordinary artisans will appreciate thatall ranges and values between these explicitly articulated values arecontemplated. Such small molecules may be polymers or non-polymers andnatural or synthetic.

Precursors that are not dendrimers may be used. Dendritic molecules arehighly branched radially symmetrical polymers in which the atoms arearranged in many arms and subarms radiating out from a central core.Dendrimers are characterized by their degree of structural perfection asbased on the evaluation of both symmetry and polydispersity and requireparticular chemical processes to synthesize. Accordingly, an artisan canreadily distinguish dendrimer precursors from non-dendrimer precursors.Dendrimers have a shape that is typically dependent on the solubility ofits component polymers in a given environment, and can changesubstantially according to the solvent or solutes around it, e.g.,changes in temperature, pH, or ion content.

Precursors may be dendrimers, e.g., as in U.S. Publication Nos.2004/0086479 and 2004/0131582 and PCT Publication Nos. WO2007005249,WO2007001926 and WO2006031358, or the U.S. counterparts thereof;dendrimers may also be useful as multifunctional precursors, e.g., as inU.S. Publication Nos. 2004/0131582 and 2004/0086479 and PCT PublicationNo. WO2006031388; each of which US and PCT applications are herebyincorporated by reference herein in its entirety to the extent they donot contradict what is explicitly disclosed herein. Dendrimers arehighly ordered possess high surface area to volume ratios, and exhibitnumerous end groups for potential functionalization. Embodiments includemultifunctional precursors that are not dendrimers.

Some embodiments include a precursor that consists essentially of anoligopeptide sequence of no more than five residues, e.g., amino acidscomprising at least one amine, thiol, carboxyl, or hydroxyl side chain.A residue is an amino acid, either as occurring in nature or derivitizedthereof. The backbone of such an oligopeptide may be natural orsynthetic. In some embodiments, peptides of two or more amino acids arecombined with a synthetic backbone to make a precursor; certainembodiments of such precursors have a molecular weight in the range ofabout 100 to about 10,000 or about 300 to about 500 Artisans willimmediately appreciate that all ranges and values between theseexplicitly articulated bounds are contemplated.

Precursors may be prepared to be free of amino acid sequences cleavableby enzymes present at the site of introduction, including free ofsequences susceptible to attach by metalloproteinases and/orcollagenases. Further, precursors may be made to be free of all aminoacids, or free of amino acid sequences of more than about 50, 30, 20,10, 9, 8, 7, 6, 5, 4, 3, 2, or 1 amino acids. Precursors may benon-proteins, meaning that they are not a naturally occurring proteinand cannot be made by cleaving a naturally occurring protein and cannotbe made by adding synthetic materials to a protein. Precursors may benon-collagen, non-fibrin, non-fibrinogen, and non-albumin, meaning thatthey are not one of these proteins and are not chemical derivatives ofone of these proteins. The use of non-protein precursors and limited useof amino acid sequences can be helpful for avoiding immune reactions,avoiding unwanted cell recognition, and avoiding the hazards associatedwith using proteins derived from natural sources. Precursors can also benon-saccharides (free of saccharides) or essentially non-saccharides(free of more than about 5% saccharides by w/w of the precursormolecular weight. Thus a precursor may, for example, exclude hyaluronicacid, heparin, or gellan. Precursors can also be both non-proteins andnon-saccharides.

Peptides may be used as precursors. In general, peptides with less thanabout 10 residues are preferred, although larger sequences (e.g.,proteins) may be used. Artisans will immediately appreciate that everyrange and value within these explicit bounds is included, e.g., 1-10,2-9, 3-10, 1, 2, 3, 4, 5, 6, or 7. Some amino acids have nucleophilicgroups (e.g., primary amines or thiols) or groups that can bederivitized as needed to incorporate nucleophilic groups orelectrophilic groups (e.g., carboxyls or hydroxyls). Polyamino acidpolymers generated synthetically are normally considered to be syntheticif they are not found in nature and are engineered not to be identicalto naturally occurring biomolecules.

Some hydrogels are made with a polyethylene glycol-containing precursor.Polyethylene glycol (PEG, also referred to as polyethylene oxide whenoccurring in a high molecular weight) refers to a polymer with a repeatgroup (CH₂CH₂O)_(n), with n being at least 3. A polymeric precursorhaving a polyethylene glycol thus has at least three of these repeatgroups connected to each other in a linear series. The polyethyleneglycol content of a polymer or arm is calculated by adding up all of thepolyethylene glycol groups on the polymer or arm, even if they areinterrupted by other groups. Thus, an arm having at least 1000 MWpolyethylene glycol has enough CH₂CH₂O groups to total at least 1000 MW.As is customary terminology in these arts, a polyethylene glycol polymerdoes not necessarily refer to a molecule that terminates in a hydroxylgroup. Molecular weights are abbreviated in thousands using the symbolk, e.g., with 15K meaning 15,000 molecular weight, i.e., 15,000 Daltons.NH2 refers to an amine termination. SG refers to succinimidyl glutarate.SS refers to succinimidyl succinate. SAP refers to succinimidyl adipate.SAZ refers to succinimidyl azelate. SS, SG, SAP and SAZ are succinimidylesters that have an ester group that degrades by hydrolysis in water.Hydrolytically degradable or water-degradable thus refers to a materialthat would spontaneously degrade in vitro in an excess of water withoutany enzymes or cells present to mediate the degradation. A time fordegradation refers to effective disappearance of the material as judgedby the naked eye. Trilysine (also abbreviated LLL) is a synthetictripeptide. PEG and/or hydrogels, as well as compositions that comprisethe same, may be provided in a form that is pharmaceutically acceptable,meaning that it is highly purified and free of contaminants, e.g.,pyrogens.

Hydrogel Structures

The hydrogel's structure and the material composition of the hydrogel'sprecursors determine its properties. Precursor factors includeproperties such as biocompatibility, water solubility, hydrophilicity,molecular weight, arm length, number of arms, functional groups,distance between crosslinks, degradability, and the like. The choice ofreaction conditions also effects the hydrogel's structure andproperties, including choices of solvents, reaction schemes, reactantconcentrations, solids content, and the like. There can be a variety ofways to achieve certain properties, or combination of properties. On theother hand some properties are in tension with each other, for instancebrittleness may increase as a distance between crosslinks decreases orsolids content increases. Strength may be increased by increasing thenumber of crosslinks but swelling may thereby be reduced. Artisans willappreciate that the same materials may be used to make matrices with agreat range of structures that will have highly distinct mechanicalproperties and performance, such that the achievement of a particularproperty should not be merely assumed based on the general types ofprecursors that are involved.

The spacing between molecular strands of the hydrogel (the matrix)affects several hydrogel properties, including a rate of diffusion ofmolecules. The crosslinking density can be controlled by the choice ofthe overall molecular weight of the precursor(s) used as crosslinker(s)and other precursor(s) and the number of functional groups available perprecursor molecule. A lower molecular weight between crosslinks such as200 will give much higher crosslinking density as compared to a highermolecular weight between crosslinks such as 500,000; artisans willimmediately appreciate that all ranges and values within this range arecontemplated and supported, e.g., 200 to 250,000, 500 to 400,000, and soforth. The crosslinking density also may be controlled by the overallpercent solids of the crosslinker and functional polymer solutions. Yetanother method to control crosslink density is by adjusting thestoichiometry of nucleophilic functional groups to electrophilicfunctional groups. A one to one ratio leads to the highest crosslinkdensity. Precursors with longer distances between crosslinkable sitesform gels that are generally softer, more compliant, and more elastic.Thus an increased length of a water-soluble segment, such as apolyethylene glycol, tends to enhance elasticity to produce desirablephysical properties. Thus certain embodiments are directed to precursorswith water soluble segments having molecular weights in the range of1,000 to 100,000; artisans will immediately appreciate that all theranges and values within the explicitly stated ranges are contemplated,e.g. 5,000 to 35,000. The solids content of the hydrogel can affect itsmechanical properties and biocompatibility and reflects a balancebetween competing requirements. A relatively low solids content isuseful, e.g., between about 2.5% to about 20%, including all ranges andvalues there between, e.g., about 2.5% to about 10%, about 5% to about15%, or less than about 15%.

In some embodiments, lower molecular weight precursors allow for fairlystiff mechanical stenting of the luminal wall using a hydrogel. Becausethe hydrogel is embedded in the luminal wall, it is less likely tofragment. A person of ordinary skill in the art will recognize thatadditional ranges are contemplated and are within the presentdisclosure.

In some embodiments, the precursors may be able to be diluted prior toreacting. This allows any residue left with in the lumen to be diluteddownstream.

In some embodiments, the hydrogel is designed to gel in between about 1minute and about 10 minutes. In further embodiments the hydrogel isdesigned to gel in between about 1 minute and about 5 minutes, or inbetween about 1 minute and about 3 minutes. A person of ordinary skillin the art will recognize that additional ranges are contemplated andare within the present disclosure.

Functional Groups

The precursors for covalent crosslinking have functional groups thatreact with each other to form the material via covalent bonds, eitheroutside a patient, or in situ. The functional groups generally arepolymerizable, a broad category that encompasses free radical, addition,and condensation polymerization and also groups forelectrophile-nucleophile reactions. Various aspects of polymerizationreactions are discussed in the precursors section herein.

Thus in some embodiments, precursors have a polymerizable group that isactivated by photoinitiation or redox systems as used in thepolymerization arts, or electrophilic functional groups, for instance:carbodiimidazole, sulfonyl chloride, chlorocarbonates,n-hydroxysuccinimidyl ester, succinimidyl ester or sulfasuccinimidylesters, or as in U.S. Pat. No. 5,410,016 or 6,149,931, each of which arehereby incorporated by reference herein in its entirety to the extentthey do not contradict what is explicitly disclosed herein. Thenucleophilic functional groups may be, for example, amine, hydroxyl,carboxyl, and thiol. Another class of electrophiles are acyls, e.g., asin U.S. Pat. No. 6,958,212, which describes, among other things, Michaeladdition schemes for reacting polymers.

Certain functional groups, such as alcohols or carboxylic acids, do notnormally react with other functional groups, such as amines, underphysiological conditions (e.g., pH 7.2-11.0, 37° C.). However, suchfunctional groups can be made more reactive by using an activating groupsuch as N-hydroxysuccinimide. Certain activating groups includecarbonyldiimidazole, sulfonyl chloride, aryl halides, sulfosuccinimidylesters, N-hydroxysuccinimidyl ester, succinimidyl ester, epoxide,aldehyde, maleimides, imidoesters and the like. The N-hydroxysuccinimideesters or N-hydroxysulfosuccinimide (NHS) groups are useful groups forcrosslinking of proteins or amine-containing polymers, e.g., aminoterminated polyethylene glycol. An advantage of an NHS-amine reaction isthat the reaction kinetics are favorable, but the gelation rate may beadjusted through pH or concentration. The NHS-amine crosslinkingreaction leads to formation of N-hydroxysuccinimide as a side product.Sulfonated or ethoxylated forms of N-hydroxysuccinimide have arelatively increased solubility in water and hence their rapid clearancefrom the body. An NHS-amine crosslinking reaction may be carried out inaqueous solutions and in the presence of buffers, e.g., phosphate buffer(pH 5.0-7.5), triethanolamine buffer (pH 7.5-9.0), or borate buffer (pH9.0-12), or sodium bicarbonate buffer (pH 9.0-10.0). Aqueous solutionsof NHS based crosslinkers and functional polymers preferably are madejust before the crosslinking reaction due to reaction of NHS groups withwater. The reaction rate of these groups may be delayed by keeping thesesolutions at lower pH (pH 4-7). Buffers may also be included in thehydrogels introduced into a body.

In some embodiments, each precursor comprises only nucleophilic or onlyelectrophilic functional groups, so long as both nucleophilic andelectrophilic precursors are used in the crosslinking reaction. Thus,for example, if a crosslinker has nucleophilic functional groups such asamines, the functional polymer may have electrophilic functional groupssuch as N-hydroxysuccinimides. On the other hand, if a crosslinker haselectrophilic functional groups such as sulfosuccinimides, then thefunctional polymer may have nucleophilic functional groups such asamines or thiols. Thus, functional polymers such as proteins, poly(allylamine), or amine-terminated di-or multifunctional poly(ethylene glycol)can be used.

One embodiment has reactive precursor species with 2 to 16 nucleophilicfunctional groups each and reactive precursor species with 2 to 16electrophilic functional groups each; artisans will immediatelyappreciate that all the ranges and values within the explicitly statedranges are contemplated, for instance 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,12, 13, 14, 15, or 16 groups.

The functional groups may be, e.g., electrophiles reactable withnucleophiles, groups reactable with specific nucleophiles, e.g., primaryamines, groups that form amide bonds with materials in the biologicalfluids, groups that form amide bonds with carboxyls, activated-acidfunctional groups, or a combination of the same. The functional groupsmay be, e.g., a strong electrophilic functional group, meaning anelectrophilic functional group that effectively forms a covalent bondwith a primary amine in aqueous solution at pH 9.0 at room temperatureand pressure and/or an electrophilic group that reacts by a ofMichael-type reaction. The strong electrophile may be of a type thatdoes not participate in a Michaels-type reaction or of a type thatparticipates in a Michaels-type reaction.

A Michael-type reaction refers to the 1, 4 addition reaction of anucleophile on a conjugate unsaturated system. The addition mechanismcould be purely polar, or proceed through a radical-like intermediatestate(s); Lewis acids or appropriately designed hydrogen bonding speciescan act as catalysts. The term conjugation can refer both to alternationof carbon-carbon, carbon-heteroatom or heteroatom-heteroatom multiplebonds with single bonds, or to the linking of a functional group to amacromolecule, such as a synthetic polymer or a protein. Michael-typereactions are discussed in detail in U.S. Pat. No. 6,958,212, which ishereby incorporated by reference herein in its entirety for all purposesto the extent it does not contradict what is explicitly disclosedherein.

Examples of strong electrophiles that do not participate in aMichaels-type reaction are: succinimides, succinimidyl esters, orNHS-esters. Examples of Michael-type electrophiles are acrylates,methacrylates, methylmethacrylates, and other unsaturated polymerizablegroups.

Initiating Systems

Some precursors react using initiators. An initiator group is a chemicalgroup capable of initiating a free radical polymerization reaction. Forinstance, it may be present as a separate component, or as a pendentgroup on a precursor. Initiator groups include thermal initiators,photoactivatable initiators, and oxidation-reduction (redox) systems.Long wave UV and visible light photoactivatable initiators include, forexample, ethyl eosin groups, 2, 2-dimethoxy-2-phenyl acetophenonegroups, other acetophenone derivatives, thioxanthone groups,benzophenone groups, and camphorquinone groups. Examples of thermallyreactive initiators include 4, 4′ azobis (4-cyanopentanoic acid) groups,and analogs of benzoyl peroxide groups. Several commercially availablelow temperature free radical initiators, such as V-044, available fromWako Chemicals USA, Inc., Richmond, Va., may be used to initiate freeradical crosslinking reactions at body temperatures to form hydrogelcoatings with the aforementioned monomers.

Metal ions may be used either as an oxidizer or a reductant in redoxinitiating systems. For example, ferrous ions may be used in combinationwith a peroxide or hydroperoxide to initiate polymerization, or as partsof a polymerization system. In this case, the ferrous ions would serveas a reductant. Alternatively, metal ions may serve as an oxidant. Forexample, the ceric ion (4+ valence state of cerium) interacts withvarious organic groups, including carboxylic acids and urethanes, toremove an electron to the metal ion, and leave an initiating radicalbehind on the organic group. In such a system, the metal ion acts as anoxidizer. Potentially suitable metal ions for either role are any of thetransition metal ions, lanthanides and actinides, which have at leasttwo readily accessible oxidation states. Particularly useful metal ionshave at least two states separated by only one difference in charge. Ofthese, the most commonly used are ferric/ferrous; cupric/cuprous;ceric/cerous; cobaltic/cobaltous; vanadate V vs. IV; permanganate; andmanganic/manganous. Peroxygen containing compounds, such as peroxidesand hydroperoxides, including hydrogen peroxide, t-butyl hydroperoxide,t-butyl peroxide, benzoyl peroxide, cumyl peroxide may be used.

An example of an initiating system is the combination of a peroxygencompound in one solution, and a reactive ion, such as a transitionmetal, in another. In this case, no external initiators ofpolymerization are needed and polymerization proceeds spontaneously andwithout application of external energy or use of an external energysource when two complementary reactive functional groups containingmoieties interact at the application site.

Visualization Agents

A visualization agent may be used as a powder in a xerogel/hydrogel; itreflects or emits light at a wavelength detectable to a human eye sothat a user applying the hydrogel could observe the object when itcontains an effective amount of the agent. Agents that require a machineaid for imaging are referred to as imaging agents herein, and examplesinclude: radioopaque contrast agents and ultrasound contrast agents.Some biocompatible visualization agents are FD&C BLUE #1, FD&C BLUE #2,and methylene blue. These agents are preferably present in the finalelectrophilic-nucleophilic reactive precursor species mix at aconcentration of more than 0.05 mg/ml and preferably in a concentrationrange of at least 0.1 to about 12 mg/ml, and more preferably in therange of 0.1 to 4.0 mg/ml, although greater concentrations maypotentially be used, up to the limit of solubility of the visualizationagent. Visualization agents may be covalently linked to the molecularnetwork of the xerogel/hydrogel, thus preserving visualization afterapplication to a patient until the hydrogel hydrolyzes to dissolution.Visualization agents may be selected from among any of the variousnon-toxic colored substances suitable for use in medical implantablemedical devices, such as FD&C BLUE dyes 3 and 6, eosin, methylene blue,indocyanine green, or colored dyes normally found in synthetic surgicalsutures. Reactive visualization agents such as NHS-fluorescein can beused to incorporate the visualization agent into the molecular networkof the xerogel/hydrogel. The visualization agent may be present witheither reactive precursor species, e.g., a crosslinker or functionalpolymer solution. The preferred colored substance may or may not becomechemically bound to the hydrogel.

Biodegradation

A hydrogel may be formed so that, upon hydration in physiologicalsolution, a hydrogel is formed that is water-degradable, as measurableby the hydrogel losing its mechanical strength and eventuallydissipating in vitro in an excess of water by hydrolytic degradation ofwater-degradable groups. This test is predictive ofhydrolytically-driven dissolution in vivo, a process that is in contrastto cell or protease-driven degradation. Significantly, however,polyanhydrides or other conventionally-used degradable materials thatdegrade to acidic components tend to cause inflammation in tissues. Thehydrogels, however, may exclude such materials, and may be free ofpolyanhydrides, anhydride bonds, or precursors that degrade into acid ordiacids. The term degradation by solvation in water, also referred to asdissolving in water, refers to a process of a matrix gradually goinginto solution in, which is a process that cannot take place for acovalently crosslinked material and materials insoluble in water.

For example, electrophilic groups such as SG (N-hydroxysuccinimidylglutarate), SS (N-hydroxysuccinimidyl succinate), SC(N-hydroxysuccinimidyl carbonate), SAP (N-hydroxysuccinimidyl adipate)or SAZ (N-hydroxysuccinimidyl azelate) may be used and have estericlinkages that are hydrolytically labile. More linear hydrophobiclinkages such as pimelate, suberate, azelate or sebacate linkages mayalso be used, with these linkages being less degradable than succinate,glutarate or adipate linkages. Branched, cyclic or other hydrophobiclinkages may also be used. Polyethylene glycols and other precursors maybe prepared with these groups. The crosslinked hydrogel degradation mayproceed by the water-driven hydrolysis of the biodegradable segment whenwater-degradable materials are used. Polymers that include esterlinkages may also be included to provide a desired degradation rate,with groups being added or subtracted near the esters to increase ordecrease the rate of degradation. Thus it is possible to construct ahydrogel with a desired degradation profile, from a few days to manymonths, using a degradable segment. If polyglycolate is used as thebiodegradable segment, for instance, a crosslinked polymer could be madeto degrade in about 1 to about 30 days depending on the crosslinkingdensity of the network. Similarly, a polycaprolactone based crosslinkednetwork can be made to degrade in about 1 to about 8 months. Thedegradation time generally varies according to the type of degradablesegment used, in the following order:polyglycolate<polylactate<polytrimethylene carbonate<polycaprolactone.Thus it is possible to construct a hydrogel with a desired degradationprofile, from a few days to many months, using a degradable segment.Some embodiments include precursors that are free of adjacent estergroups and/or have no more than one ester group per arm on one or moreof the precursors: control of the number and position of the esters canassist in uniform degradation of the hydrogel.

A biodegradable linkage in the organogel and/or xerogel and/or hydrogeland/or precursor may be water-degradable or enzymatically degradable.Illustrative water-degradable biodegradable linkages include polymers,copolymers and oligomers of glycolide, dl-lactide, 1-lactide, dioxanone,esters, carbonates, and trimethylene carbonate. Illustrativeenzymatically biodegradable linkages include peptidic linkages cleavableby metalloproteinases and collagenases. Examples of biodegradablelinkages include polymers and copolymers of poly(hydroxy acid)s,poly(orthocarbonate)s, poly(anhydride)s, poly(lactone)s,poly(aminoacid)s, poly(carbonate)s, and poly(phosphonate)s.

If it is desired that a biocompatible crosslinked matrix bebiodegradable or absorbable, one or more precursors having biodegradablelinkages (or just one biodegradable linkage, for example an ester)present in between the functional groups may be used. The biodegradablelinkage optionally also may serve as the water soluble core of one ormore of the precursors used to make the matrix. For each approach,biodegradable linkages may be chosen such that the resultingbiodegradable biocompatible crosslinked polymer will degrade or beabsorbed in a desired period of time.

Hydrogel Loading with Agents; Preparation as Particles

One approach for making a hydrogel or organogel with a therapeutic agentis to form it around the agent. For instance, a first precursor is addedto a solvent-protein mixture, followed by a second precursor that isreactive with the first precursor to form crosslinks. After formation ofthe matrix in the solvent, the solvent may be removed to form a xerogel.Potential processes include, e.g., precipitation with non-solvent,nitrogen sweep drying, vacuum drying, freeze-drying, a combination ofheat and vacuum, and lyophilization. If molten precursors are used inthe absence of a tertiary solvent, there is no need to employ anysolvent removal process. Upon cooling the material forms a rubbery solid(if above Tm), a semirigid semicrystalline material (if below Tm) or arigid glassy solid (if below Tg). These materials are more dense thanxerogels formed from organic solvents. When filled with particles ofother materials, e.g., therapeutic agents, buffer salts, visualizationagents, they can be highly porous, since the solid particles create andfill the pores.

In some embodiments, the agent or agents are present in a separate phasewhen precursors are reacted. The separate phase could be oil (oil-inwater emulsion), or an immiscible solvent, a liposome, a micelle, abiodegradable vehicle, and the like. Biodegradable vehicles in which theactive agent may be present include: encapsulation vehicles, such asmicroparticles, microspheres, microbeads, micropellets, where the activeagent is encapsulated in a bioerodable or biodegradable polymers such aspolymers and copolymers of: poly(anhydride), poly(hydroxy acid)s,poly(lactone)s, poly(trimethylene carbonate), poly(glycolic acid),poly(lactic acid), poly(glycolic acid)-co-poly(glycolic acid),poly(orthocarbonate), poly(caprolactone), crosslinked biodegradablehydrogel networks like fibrin glue or fibrin sealant, caging andentrapping molecules, like cyclodextrin, molecular sieves and the like.Microspheres made from polymers and copolymers of poly (lactone) s andpoly (hydroxy acid) are particularly preferred as biodegradableencapsulation vehicles. The therapeutic agent or encapsulatedtherapeutic agent may be present in solution or suspended form. Someagents are highly soluble while others are effectively insoluble inaqueous solution and can form their own phase when exposed to aqueoussolvent.

Therapeutic agents can be in solid particulate form in the hydrogel,e.g., as a powder. For instance, water soluble biologics (e.g.,proteins) in solid phase can be ground or otherwise formed into a finepowder that is added to the precursors when a matrix is formed. Thepeptide or other water soluble biologic may be in a solid phase, may beall crystalline, partially crystalline, or essentially free of crystals(meaning more than 90% free of crystals w/w; artisans will immediatelyappreciate that all the ranges and values within the explicitly statedranges are contemplated). A powder of a protein refers to a powder madefrom one or more proteins. Similarly, powders of water soluble biologicsare powders having particles made of one or more water solublebiologics. The powders and/or xerogels and/or organogels and/orhydrogels that contain them may be free of encapsulating materials andbe free of one or more of a liposome, micelle, or nanocapsule. Further,a protein particle or a water soluble biologic particle may be made thatis free of one or more of: binders, non-peptidic polymers, surfactants,oils, fats, waxes, hydrophobic polymers, polymers comprising alkylchains longer than 4 CH₂ groups, phospholipids, micelle-formingpolymers, micelle-forming compositions, amphiphiles, polysaccharides,polysaccharides of three or more sugars, fatty acids, and lipids.Lyophilized, spray dried or otherwise processed proteins are oftenformulated with sugars such as trehalose to stabilize the proteinthrough the lyophilization or other processes used to prepare theproteins. These sugars may be allowed to persist in the particlethroughout the organogel/xerogel process. The particles may be made tocomprise between about 20% and about 100% (dry w/w) protein; artisanswill immediately appreciate that all the ranges and values within theexplicitly stated ranges are contemplated, e.g., about 50% to about 80%or at least 90% or at least about 99%. A number of factors can becontrolled that contribute to processing and delivery of a proteinwithout denaturation. The protein may be prepared as a powder, with thepowder particle size being chosen in light of the size of the ultimatehydrogel/organogel/xerogel particle. Organic solvents for the proteinsmay be chosen so that the proteins are not solvated by the organicsolvents and are compatible with the protein. Another factor is oxygen,and elimination of oxygen is helpful in processing to avoiddenaturation. Another factor is chemical reactions. These may be avoidedby keeping the protein in a solid phase and free of solvents thatdissolve the protein until such time as the protein is implanted.

An organogel or hydrogel may be formed and then reduced to particlesthat are subsequently treated to remove the organic or aqueous solventor solvents to form a xerogel. For an injectable form, the organogel orhydrogel can be macerated, homogenized, extruded, screened, chopped,diced, or otherwise reduced to a particulate form. Alternatively, theorganogel or hydrogel can be formed as a droplet or a molded articlecontaining the suspended protein particles. One process for making suchparticles involves creation of a material that is broken up to make theparticles. One technique involves preparing the organogel or hydrogelwith protein particles and grinding it, e.g., in a ball mill or with amortar and pestle. The matrix may be chopped or diced with knives orwires. Or the matrix may be cut-up in a blender or homogenizer. Anotherprocess involves forcing the organogel through a mesh, collecting thefragments, and passing them through the same mesh or another mesh untila desired size is reached.

The particles of biologics or the particles or organogels or theparticles of the xerogels may be separated into collections with adesired size range and distribution of sizes by a variety of methods.Very fine control of sizing is available, with sizes ranging from 1micron to several mm, and with a mean and range of particles sizes beingcontrollable with a narrow distribution. Artisans will immediatelyappreciate that all the ranges and values within the explicitly statedranges are contemplated, e.g., from about 1 to about 10 μm or from about1 to about 30 μm. About 1 to about 500 microns is another such rangethat is useful, with sizes falling throughout the range and having amean sizing at one value within the range, and a standard deviationcentered around the mean value, e.g., from about 1% to about 100%. Asimple method for sizing particles involves using custom-made orstandardized sieve mesh sizes. The term particle is broad and includesspheres, discs, and irregularly shaped particles. A spheroidal particlerefers to a particle wherein the longest central axis (a straight linepassing through the particle's geometric center) is no more than abouttwice the length of other central axes, with the particle being aliterally spherical or having an irregular shape. A rod-shaped particlerefers to a particle with a longitudinal central axis more than abouttwice the length of the shortest central axis. Embodiments includemaking a plurality of collections of particles, with the collectionshaving different rates of degradation in vivo, and mixing collections tomake a biomaterial having a degradation performance as desired.

Pastes may be prepared that comprise the particles. The particles areprepared with a liquid, typically an aqueous, pharmaceuticallyacceptable liquid. The particles can be added to aqueous solution andthen the water can be removed by filtering, vacuum, freeze drying,and/or gentle heat. The particles can be quickly removed from thesolution, or may be allowed to hydrate or partially hydrate beforeprocessing them to form a paste.

The Lumen

Administration of a hydrogel may be performed directly into the site ofinterest. Embodiments of the invention include administration in or neara luminal wall. An anatomical lumen is an inner open space or cavity ofan organ. For example, a blood vessel, ureter, esophagus, bile duct, oran intestine has a lumen. The lumen may be permanent, e.g., a bloodvessel, or potential, e.g., Denonvilliers space. The structure of ablood vessel, for example, can be divided into three main layers ortunics: the tunica intima, the tunica media, and the tunica adventitia.The tunica intima is the innermost layer of the vessel wall. It is athin layer of endothelial cells which lines the circulator system. Thetunica media is the muscular middle layer of arteries and veins. Itcontains the smooth muscle, as well as elastic fiber and connectivetissue. The tunica adventitia is made entirely of connective tissue andcontains the nerves that supply the vessels. Other body lumens may alsobenefit from stenting including, for example, the urethra. The luminalwalls of other lumens contain other layers and structures. These layersare referred to in this application generally as the endoluminal wall,referring to the innermost layer, and the outer wall, referring to theoutermost layer.

In use, for example a balloon catheter or other device is used todeliver precursors. When precursors are delivered, they are chosen sothey form hydrogel in situ. The term in situ refers to forming thedevice, hydrogel, or gel at the site of intended use; for implantedmaterials, the site of intend use is the location of the implant, i.e.,in the body. The therapeutic agents are released from the hydrogels.Various sites may be chosen. Sites where drug delivery depots or stentsmay be formed include the luminal wall, media, adventitia, endoluminalwall, outer luminal wall, or surrounding tissues.

Placement

The delivery devices may be used to deliver their contents to any site,including any soft or hard tissue, and placement, e.g., intramuscular,intraperitoneal, subcutaneous. Their contents may be a precursor oragent as set forth herein, or other materials.

The hydrogel may be placed at a site that is suited to deliver the agentfor the pathology that is being treated. The choice of dose, size ofimplant, and position is affected by factors such as a time betweenrepeat administrations, patient comfort or compliance, and dosagereceived at a target tissue.

The hydrogel may be placed so that the hydrogel is free of contact withfluids carried by the lumen. Accordingly, the hydrogel is entirelywithin the tissue where it is placed and free of contact with fluidsexcepting fluids in, or of, the tissue. In the case of a luminal wall,the hydrogel is entirely within the wall. This placement gives theadvantage of not having sequelae and of not having hydrogel componentsor degradation products compromise the luminal patency over time. Thisplacement also offers the advantage of better retention of the hydrogelwhere it is administered, and thus prevents migration over time. Thisplacement is distinct from other approaches that place a hydrogelmaterial directly on the wall of a lumen, e.g., photopolymerizing gels.

Embodiments include placement of a bioabsorbable stent at a locus of,for example, a blood vessel, e.g., a vein, an artery, a femoral vein, aleg vein, a deep leg vein, a peripheral vein, a peripheral artery, acoronary artery and/or a stenotic portion thereof. The stent assists inmaintaining patency and may further comprise agents for delivery to thesite.

In some embodiments, an angioplasty or similar procedure is preformed todilate the lumen. A hydrogel or hydrogel precursor is injected into theluminal wall. The hydrogel is then allowed to set for at least about 1minute, at least about 2 minutes, at least about 5, or at least about 10minutes. A person of ordinary skill in the art will recognize thatadditional ranges are contemplated and are within the presentdisclosure. Expansion of the stent to its final configuration can thusbe augmented and/or facilitated by, for example, inflating a ballooncatheter in the lumen to expand the walls and provide for the stent tohave a maximal diameter and to preserve as much patency as possible.Moreover, the site can be treated before, during or after dilation ofthe lumen, for instance arterial plaque can be compressed at the time ofstent placement, before placement, or in addition to placement.

A stent and/or drug depot of the in-situ hydrogel drug delivery implantmay be designed for controlled, long term drug release ranging from,e.g., about one to about three months, or longer, depending on the site,dose, and so forth, e.g., 1-12 months.

Conditions and sites for placement of stents and/or hydrogels includeluminal walls for: stenosis or restenosis of veins, arteries, or avascular structure; for urethral stenosis of benign prostate hyperplasiaor a (benign or malignant) stricture of an esophagus; and for bile ductocclusions. A bowel lumen may be stented with a hydrogel in a bowelwall, for instance, in inflammatory bowel disease and Crohn's diseasethere are segments within the bowel that are ulcerated and needtreatment.

Placement of hydrogels in a tissue or a wall of a lumen can providestenting where conventional stents are not useful. For instance,conventional stents have a stiffness that limits the distance and thetolerable amount of tortuosity involved in threading them through avasculature to a site of use. Moreover, some conditions require lengthystenting or multiple stents that are more difficult to place, forinstance long segments of artery in peripheral artery disease.

The stents or hydrogels can carry a drug payload of various types oftherapeutic agents for various conditions, of which some include, forexample, steroids, antibiotics, NSAIDS, stabilizing agents and/orantiangiogenic agents, or combinations thereof. The in-situ implantembodiments can improve the efficacy and pharmacokinetics of potenttherapeutic agents in the treatment of chronic vascular diseases andminimize patient side effects in several ways. First, the implant can beplaced in vessel at a specific disease site, bypassing the topical orsystemic routes and thereby increasing drug bioavailability. Secondly,the implant maintains local therapeutic concentrations at the specifictarget tissue site over an extended period of time.

A hydrogel is formed in situ. In some embodiments the hydrogel iscomprised of at least 50%, 75%, 80%, 90%, or 99% w/w water-solubleprecursors (calculated by measuring the weight of the hydrophilicprecursors and dividing by the weight of all precursors, so that theweight of water or solvents or non-hydrogel components is ignored) toenhance the non-adhesive properties of the hydrogel. In someembodiments, such hydrophilic precursors substantially comprisepolyethylene oxides. In some embodiments, drugs to reduce tissueadherence mediated by biological mechanisms including cell mitosis, cellmigration, or macrophage migration or activation, are included, e.g.,anti-inflammatories, anti-mitotics, antibiotics, PACLITAXEL, MITOMYCIN,or taxols.

In some embodiments, the tunica intima may be punctured or penetratedwith a needle or catheter or trocar and precursors introduced into aspace between the intima and the media, the media and the adventitia, orother spaces in the luminal wall. In some cases the intima may bepunctured to access a natural potential space between the tissues thatis filled by the precursors. In other cases, a potential or actual spaceis created mechanically with a trocar, spreader, or the like, thatbreaks the adherence between the sclera and conjunctiva so thatprecursors may be introduced. The vessel wall has enough elasticity toallow useful amounts of precursors to be introduced or forced into suchnatural or created spaces.

In some aspects, in-situ formation of the hydrogel lets the hydrogel gelor crosslink in place, so that it does not flow back out through thetract of the needle and diffuse into the lumen through the incision siteupon the removal of the needle or cannula. A shape-stable hydrogel thusformed can effectively deliver the drug and advantageously can havewell-controlled size, shape, and surface area. A small needle may beused to inject the materials since soluble or flowable precursors may beused instead of an already-formed material. By way of contrast,alternative materials that do not cross-link quickly and firmly uponintroduction tend to flow back out of the incision. And materials thatdo not covalently cross-link are subject to creep or weeping as thematerial continually reorganizes and some or all of the material flowsout.

Materials set forth herein, e.g., precursors, hydrogels, or gels, may beplaced outside of a tissue, or may be formed anywhere outside of thelumen. In the vasculature, for instance, placement may be the media,adventitia, and the loose connective tissue blood vessels. Accordingly,delivery may be intravascular, or intraluminal in the case ofnon-vascular lumens, and the material is delivered outside of the wallof the lumen. Such materials may be for stenting, if appropriatelypositioned, and/or for delivery of a therapeutic agent.

Kits

Kits or systems for making hydrogels may be prepared so that theprecursor(s) and therapeutic agent(s) are stored in the kit withdiluents as may be needed. Applicators may be used in combination withthe same. The kits are manufactured using medically acceptableconditions and contain components that have sterility, purity andpreparation that is pharmaceutically acceptable. Solvents/solutions maybe provided in the kit or separately, or the components may be pre-mixedwith the solvent. The kit may include syringes and/or needles for mixingand/or delivery. The kit or system may comprise components set forthherein.

Administration

An embodiment is a hydrogel formed by in situ polymerization containinga therapeutic agent. In use, precursors and the agent(s) and injectedinto the site of intended use in the patient. The precursors react witheach other to form the hydrogel. A needle, cannula, trocar, sprayer, orother applicator may be used. Administration of the hydrogels and/orxerogels may also involve hydration in advance, at about the time ofuse, or at the point of use.

The materials described herein may be used to deliver drugs or othertherapeutic agents (e.g., imaging agents or markers). One mode ofapplication is to apply a mixture of precursors and other materials(e.g., therapeutic agent, buffer, accelerator, initiator) through aneedle, microneedle, cannula, catheter, or hollow wire to a site. Themixture may be delivered, for instance, with a device as set forthherein, with a manually controlled syringe, or with mechanicallycontrolled syringe, e.g., a syringe pump. Alternatively, a dual syringeor multiple-barreled syringe or multi-lumen system may be used to mixthe materials at or near the site with a hydrating fluid and/or otheragents. Balloon catheters with microneedles or one or more holes orminimally invasive injectors may be used to introduce the hydrogel intothe luminal wall, see U.S. Pat. Nos. 8,975,233, 8,771,252, 8,465,752,and US 2014/0303569.

The precursors, gels, hydrogels, pastes, fluids, or other materialsdescribed herein may be injected with a needleless injection device, seeU.S. Pat. Nos. 8,945,045, 8,876,759, and US 2011/0270216.

EXAMPLES Example 1

Preparation and Injection of Hydrogels into a Luminal Tissue

A hydrogel or hydrogel precursors may be prepared and injected intoluminal tissue using the following method. Trilysine Acetate isdissolved in a Sodium Phosphate Dibasic solution. NHS-Fluorescein(5(6)-Carboxyfluorescein, Succinimidyl Ester) (NHS-Fluorescein) isweighted and transferred to the vial containing the TrilysineAcetate/Sodium Phosphate Dibasic solution and vortexed until completelydissolved. The vial is immediately wrapped in foil to prevent lightexposure and allowed to react for 1 hour.

After 1 hour, the Trilysine Acetate/NHS-Fluorescein/Sodium PhosphateDibasic solution is aliquotted into a 5 mL syringe.

In a second 5 mL syringe, Dexamethasone, Micronized, USP is weighed. DIwater is added to the syringe. The syringe plunger is then replaced andthe syringe was vortexed to suspend the Dexamethasone.

Polyethylene glycol (PEG) end capped with succinimidylsuccinate groups(4a20kSG PEG) powder is transferred into a third 5 mL syringe, and mixedwith a Sodium Phosphate Monobasic solution to dissolve the PEG.

The contents of the PEG/Sodium Phosphate Monobasic solution syringe andthe Dexamethasone suspension syringe is combined by mating the twosyringes with a luer-luer connector and passing the contents back andforth between the two syringes for approximately 10 seconds. Theresulting mixture is then drawn into one syringe. The combined mixturecreated in the preceding step is then mixed with theTrilysine/NHS-Fluorescein/Sodium Phosphate Dibasic solution syringeusing the same mixing method. This final mixing step initiates thecrosslinking reaction, and a stopwatch is started at the onset of thisfinal mixing step.

The hydrogel precursor solution is introduced into each of threeHamilton Glass Syringes. Each is then expelled through a microneedle ofapproximately 600 μm length and varying in inner diameter from 120 μm to160 μm. The contents of each syringe are expelled freely and completelywithout visible signs of the micronized suspension remaining in thesyringe or otherwise being obstructed by the small diameter of theneedle.

Therapeutic agents for use may include, for instance, steroids,non-steroidal anti-inflammatory drugs (NSAIDS), anti-cancer drugs,antibiotics, an anti-inflammatory (e.g., Diclofenac), a pain reliever(e.g., Bupivacaine), a Calcium channel blocker (e.g., Nifedipine), anAntibiotic (e.g., Ciprofloxacin), a Cell cycle inhibitor (e.g.,Simvastatin), a protein (e.g., Insulin). Therapeutic agents includeclasses of drugs including steroids, NSAIDS, antibiotics, painrelievers, inhibitors of vascular endothelial growth factor (VEGF),chemotherapeutics, anti-viral drugs, for instance. Examples of NSAIDSare Ibuprofen, Meclofenamate sodium, mefanamic acid, salsalate,sulindac, tolmetin sodium, ketoprofen, diflunisal, piroxicam, naproxen,etodolac, flurbiprofen, fenoprofen calcium, Indomethacin, celoxib,ketrolac, and nepafenac. The drugs themselves may be small molecules,peptides, proteins, RNA fragments, glycosaminoglycans, carbohydrates,nucleic acid, inorganic and organic biologically active compounds wherespecific biologically active agents include but are not limited to:enzymes, antibiotics, antineoplastic agents, local anesthetics,hormones, angiogenic agents, anti-angiogenic agents, growth factors,antibodies, neurotransmitters, psychoactive drugs, anticancer drugs,chemotherapeutic drugs, drugs affecting reproductive organs, genes, andoligonucleotides, or other configurations.

Therapeutic agents may include a protein or other water solublebiologics. These include peptides and proteins. The term protein, asused herein, refers to peptides of at least about 5000 Daltons. The termpeptide, as used herein, refers to peptides of any size. The termoligopeptide refers to peptides having a mass of up to about 5000Daltons. Peptides include therapeutic proteins and peptides, antibodies,antibody fragments, short chain variable fragments (scFv), growthfactors, angiogenic factors, and insulin. Other water soluble biologicsare carbohydrates, polysaccharides, nucleic acids, antisense nucleicacids, RNA, DNA, small interfering RNA (siRNA), and aptamers.

Further embodiments of therapeutic agents for delivery include thosethat specifically bind a target peptide in vivo to prevent theinteraction of the target peptide with its natural receptor or otherligands. AVASTIN, for instance, contains bevacizumab, an antibody thatbinds VEGF. And AFLIBERCEPT is a fusion protein that includes portionsof a VEGF receptor to trap VEGF. An IL-1 trap that makes use of theextracellular domains of IL-1 receptors is also known; the trap blocksIL-1 from binding and activating receptors on the surface of cells.Embodiments of agents for delivery include nucleic acids, e.g.,aptamers. Pegaptanib (MACUGEN), for example, is a pegylated anti-VEGFaptamer. An advantage of the particle-and-hydrogel delivery process isthat the aptamers are protected from the in vivo environment until theyare released. Further embodiments of agents for delivery includemacromolecular drugs, a term that refers to drugs that are significantlylarger than classical small molecule drugs, i.e., drugs such asoligonucleotides (aptamers, antisense, RNAi), ribozymes, gene therapynucleic acids, recombinant peptides, and antibodies.

FURTHER DISCLOSURE

All patents, patent applications, and publications referenced herein arehereby incorporated by reference herein in their entirety; in case ofconflict, the specification is controlling. The following numberedstatements are part of the specification.

1a. A method of treating a patient comprising forming, in situ, acovalently-crosslinked hydrogel in a luminal wall of the anatomicallumen. 1b. Alternatively, a method of treating a patient comprisingforming, in situ, a hydrogel outside of a wall of a lumen, either on theinterior luminal side, or on the exterior face of the wall. 1c.Alternatively, a method of forming a gel or a hydrogel in luminal wallof an anatomical lumen or on an interior wall of an anatomical lumen, oron an exterior of an anatomical lumen. 1d. Alternatively, a method offorming a hydrogel or a gel comprising placing an applicator inside ananatomical lumen and applying the gel or hydrogel to the interior wallof the lumen, inside the wall of the lumen, on the exterior wall of thelumen, or exterior to the lumen. 2. The method of 1 (meaning 1a, or 1betc) being a method of treating a luminal pathology of the patient. 3.The method of 1 or 2 with the hydrogel providing a stent. 4. The methodof any of 1-3 wherein the hydrogel is free of contact with the lumen, isfree of contact with a contents of the lumen, is free of contact withfluids in the lumen, is contained entirely within the luminal wall, oris contained entirely within a tissue of the patient without contactwith fluids exterior to the tissue. 5. The method of any of 1-4 whereinthe hydrogel is used to treat a pathology of the luminal wall, tostrengthen the wall, or to serve as a depot to release therapeuticagents that act in the wall, that act in the tissue, or that act at asite remote from the hydrogel. 6. The method of any of 1-5 wherein thehydrogel comprises a therapeutic agent that is released from thehydrogel. 7. The method of any of 1-6 comprising introducing a hydrogelprecursor in aqueous solution at a(n injection) site in the luminal wallthat flows from the site and reacts to form the hydrogel. Alternatively,the method of any of 1-6 comprising introducing a paste at a site in theluminal wall, with the paste comprising a gel or a hydrogel. 8. Themethod of 7 wherein the precursor is a first precursor, furthercomprising a second precursor in the aqueous solution, with the firstprecursor and second precursor crosslinking with each other to form thehydrogel. 9. The method of 7 wherein the solution or the paste has afirst pH when introduced at the luminal wall and a second pH after theintroduction, with the precursor being reactive at the second pH. 10.The method of 7 further comprising an initiator chemical in the(aqueous) solution, with the initiator initiating reaction of theprecursor to form the hydrogel. 11. The method of any of 1-10 whereinthe paste, the hydrogel or the gel, at the time of completing placementof the same at an intended site, has a height from about 0.1 mm to about2 mm. Artisans will immediately appreciate that all ranges and valuesbetween the explicitly stated bounds are contemplated, with, e.g., anyof the following being available as an upper or lower limit: 0.1, 0.2,0.5, 1, 1.5, 1.9, 2. 12. The method of any of 1-11 wherein the paste,the hydrogel or the gel, at the time of completing placement of the sameat an intended site, has a surface area sized from about 1 to about 150mm². Artisans will immediately appreciate that all ranges and valuesbetween the explicitly stated bounds are contemplated, with, e.g., anyof the following being available as an upper or lower limit: 1, 2, 3, 4,5, 10, 20, 25, 30, 40, 50, 60, 80, 100, 125, 150. 13. The method of anyof 1-12 wherein the paste, the hydrogel or the gel, at the time ofcompleting placement of the same at an intended site, has a height fromabout 0.1 mm to about 2 mm and/or an area from about 10 to about 60 mm².Artisans will immediately appreciate that all ranges and values betweenthe explicitly stated bounds are contemplated, with, e.g., any of thefollowing being available as an upper or lower limit: 10, 12, 15, 20,30, 40, 50, 55, 60. 14. The method of any of 1-13 wherein the gel, thepaste, or the hydrogel, at the time of completing placement at theintended site, has a volume of between about 1 μl and about 5 ml.Artisans will immediately appreciate that all ranges and values betweenthe explicitly stated bounds are contemplated, with, e.g., any of thefollowing being available as an upper or lower limit: 1, 5, 10, 100,1000 microliters, 1.5, 2, 2.5, 3, 4, 5, ml.

15. The method of any of 1-14 wherein the paste, the hydrogel or thegel, at the time of completing placement of the same at an intendedsite, further comprises a plurality of particles that comprise thetherapeutic agent. 17. The method of 15 further comprising an additionalamount of the same or a different therapeutic agent that is not in theparticles and is in the gel, paste, or hydrogel. 18. The method of 15wherein the particles are hydrogels that comprise the agent, which is ina solution, is a solid, or is in suspension. 19. The method of 15wherein the particles are solid and comprise the agent. 20. The methodof any of 1-19 comprising the therapeutic agent as a suspension in anaqueous phase of the hydrogel. 21. The method of 1 wherein the hydrogelis low-swelling, as measurable by the hydrogel having a weightincreasing no more than about 50% upon exposure to a physiologicalsolution for twenty-four hours relative to a weight of the hydrogel atthe time of formation. 22. The method of any of 1-21 wherein the gel,paste, or hydrogel is water-degradable, as measurable by the hydrogelbeing dissolvable in vitro in an excess of water by degradation ofwater-degradable groups. 23. The method of 22 wherein thewater-degradable groups are esters. 24. The method of any of 1-23comprising the hydrogel, wherein the hydrogel is formed by combining afirst synthetic precursor comprising nucleophilic groups with a secondsynthetic precursor comprising electrophilic groups to form covalentcrosslinks by reaction of the nucleophilic groups with the electrophilicgroups to form the hydrogel. 25. The method of 24 wherein the precursoris water soluble. 26. The method of 25 wherein the hydrogel is formed bycombining a first synthetic precursor with a second synthetic precursor.27. The method of any of 1-26 with the gel, hydrogel, paste, orparticles or other delivery agents therein comprising a therapeuticagent, wherein the therapeutic agent is selected from the groupconsisting of dexamethasone, nifedipine, a steroid, an inhibitor ofvascular endothelial growth factor, an antiangiogenesis agent, a smallmolecule drug, a protein, a nucleic acid, and a growth factor. 28. Themethod of any of 1-27 with comprising a therapeutic agent, wherein thetherapeutic agent is released over a period of time that is at leastabout three days. 29. The method of any of 1-28 wherein a point at whichcumulative 80% w/w of the therapeutic agent has been released is reachedat a time between about 14 days and 9 months. Artisans will immediatelyappreciate that all ranges and values between the explicitly statedbounds are contemplated, with, e.g., any of the following beingavailable as an upper or lower limit: 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,12, weeks, 1, 2, 3, 4, 5, 6, 7, 8, 9 months. 30. The method of any of1-29 wherein the gel, hydrogel, or paste is applied at a blood vessel, avein, an artery, a femoral vein, a leg vein, a deep leg vein, aperipheral vein, a peripheral artery, or a coronary artery. The site maybe, e.g., a stenotic site thereof. 31. The method of 30 furthercomprising puncturing an intima to access the media or the adventitia.32. The method of any of 1-31 wherein the hydrogel is formed bycombining a first precursor with a second precursor and allowing it togel for at least about 1 minute. 33. The method of any of 1-31 wherein asite of application is in, on, or near a wall, wherein the wall has apathology, the pathology being, e.g, a plaque, a weakness, an aneurysm,a disease, or a stenosis. 34. The method of 30 or 31 further comprisingpuncturing an endothelial wall. 35. The method of any of 1-34 whereinthe wall, e.g., an endothelial wall, is punctured using a microneedle,hydraulics, or a combination thereof. 36. The method of any of 1-35comprising administering the gel, paste, hydrogel, or precursor with aminimally invasive applicator comprising a needleless injector, amicroneedle, or ports positioned in contact with a wall of a lumen. 37.The method of 36 wherein the needleless injector comprises a highpressure injector for moving the gel, paste, hydrogel, or precursor outof the applicator at high pressure and/or high velocity. 38. The methodof 36 or 37 wherein the applicator comprises a balloon with microneedlesand/or ports, e.g., comprising positioning a balloon catheter in contactwith the luminal wall at a therapeutic site. 39. The method of any of1-38 wherein the luminal wall is that of a blood vessel, ureter, vein,artery, aorta, bile duct, ureter, intestine, part of a gastrointestinaltract, esophagus, lymph duct, an aneurysm, a brain aneurysm, anabdominal aortic aneurysm, or a cardiac blood vessel, or a peripheralblood vessel. Ureter, blood vessel, vein, artery, aorta, an aneurysm, abrain aneurysm, an abdominal aortic aneurysm, or a cardiac blood vessel.40. The method of any of 1-38 comprising placement of the gel, hydrogel,paste, or precursor for stenosis or restenosis of veins, arteries, or avascular structure; for urethral stenosis of benign prostate hyperplasiaor a (benign or malignant) stricture of an esophagus; or for a bile ductocclusion. 41. The method of any of 1-38 comprising placement of thegel, hydrogel, paste, or precursor for a bowel lumen for stenting (in) abowel wall, for instance, in inflammatory bowel disease or Crohn'sdisease, for one or more segments within the bowel that are, e.g.,ulcerated and/or in need of treatment. 42. The method of any of 1-39comprising expanding a lumen before, during, or after placement of thematerial, e.g., gel, hydrogel, paste, or precursor. 43. The method of 42comprising expanding the lumen with a balloon or a conventional stent(wire mesh, expandable stent, coronary artery stent, conventionalvascular prosthesis). 44. The method of 43 comprising expanding thelumen and introducing the hydrogel, gel, paste, or precursor while thelumen is expanded, providing time for the hydrogel or other material tocrosslink or otherwise gain mechanical strength, and removing the deviceused to expand the lumen, leaving the stenting material in place.

45. An injection device for injection into a tissue, for example aluminal wall, comprising a balloon catheter and an injection port forexpelling a fluent material (e.g., gel, paste, hydrogel, or precursor)from the device into the luminal wall, with the balloon in fluidcommunication with a reservoir. Alternatively, an injection device forinjection into a tissue, for example a luminal wall, comprising ahelical or woven expandable tube (e.g., hydrotube) comprising aninjection port for expelling fluent material (e.g., gel, paste,hydrogel, or precursor) from the device into the luminal wall.Alternatively, an injection device for injection into a tissue, forexample a luminal wall, comprising a resilient curved needle and apushing mandrel, e.g., with the needle disposed in a tube untilpositioned proximate the wall or other site and then pushed into thesite with the pushing mandrel. 46. The device of 45 wherein theinjection port is a hole. 47. The device of 45 wherein the injectionport is a micro needle. 48. The device of any of 45-47 furthercomprising a tube adjacent to the balloon catheter wherein the tubecomprises the injection port. 49. The device of 45 comprising themandrel, wherein the pushing mandrel is flexible. 50. A method of usinga device of any of 45-49 for injecting a gel, paste, hydrogel, orprecursor, or a material of, or for the use of, any of 1-44.

51a. A stent for stenting a lumen that comprises the stent being made ofa gel, paste, or hydrogel and being within the wall of an anatomicallumen, e.g., entirely within the wall. 51b. A luminal stent comprising agel, hydrogel, or paste disposed entirely within a wall of a lumen. 52.For instance, the stent may be interior to the luminal surface, interiorto an endothelial cell layer, interior to an intima, interior to apseudointima, disposed in a space between the intima and the media,between the media and the adventitia, or being in the luminal wall. 53.The stent of 51 or 52 with the hydrogel being entirely within the tissuewhere it is placed and free of contact with fluids excepting fluids in,or of, the tissue. 54. The stent of 51 or 52 with the hydrogel beingentirely within the wall and free of contact with the lumen and fluidsin the lumen. 55. The stent of 51 or 52 wherein the stent is in avascular wall and is interior to the adventitia and exterior to theintima. 56. The stent of any of 52-55 as placed by the method of any or1-44, or comprising the gel, hydrogel, paste, or precursor of any of1-44. 57. The stent of any of 52-55 being biodegradable ornonbiodegradable. 58. The stent of any of 52-55 wherein the stentcomprises a therapeutic agent that is released from the stent. 59. Thestent of any of 52-58 wherein the stent is a hydrogel and comprises thereaction product of a first precursor and a second precursor, with thefirst precursor and second precursor crosslinking with each other toform the hydrogel. 60. The stent of any of 52-59 wherein the stent, atthe time of completing placement of the same at an intended site, has aheight from about 0.1 mm to about 2 mm. Artisans will immediatelyappreciate that all ranges and values between the explicitly statedbounds are contemplated, with, e.g., any of the following beingavailable as an upper or lower limit: 0.1, 0.2, 0.5, 1, 1.5, 1.9, 2. 61.The stent of any of 52-60 wherein the stent, at the time of completingplacement of the same at an intended site, has a surface area sized fromabout 1 to about 150 mm². Artisans will immediately appreciate that allranges and values between the explicitly stated bounds are contemplated,with, e.g., any of the following being available as an upper or lowerlimit: 1, 2, 3, 4, 5, 10, 20, 25, 30, 40, 50, 60, 80, 100, 125, 150. 62.The stent of any of 52-61 wherein the stent, at the time of completingplacement of the same at an intended site, has a height from about 0.1mm to about 2 mm and/or an area from about 10 to about 60 mm². Artisanswill immediately appreciate that all ranges and values between theexplicitly stated bounds are contemplated, with, e.g., any of thefollowing being available as an upper or lower limit: 10, 12, 15, 20,30, 40, 50, 55, 60. 63. The stent of any of 52-62 wherein the stent, atthe time of completing placement at the intended site, has a volume ofbetween about 1 μl and about 5 ml. Artisans will immediately appreciatethat all ranges and values between the explicitly stated bounds arecontemplated, with, e.g., any of the following being available as anupper or lower limit: 1, 5, 10, 100, 1000 microliters, 1.5, 2, 2.5, 3,4, 5, ml. 64. The stent of any of 52-65 wherein the stent, at the timeof completing placement of the same at an intended site, furthercomprises a plurality of particles that comprise the therapeutic agent.65. The stent of any of 52-64 wherein the stent, is a low-swellinghydrogel, as measurable by the hydrogel having a weight increasing nomore than about 50% upon exposure to a physiological solution fortwenty-four hours relative to a weight of the hydrogel at the time offormation. 66. The stent of any of 52-65 wherein the stent iswater-degradable, as measurable by the hydrogel being dissolvable invitro in an excess of water by degradation of water-degradable groups.67. The stent of any of 52-66 wherein the stent is a hydrogel andcomprises the reaction product of formed by combining a first syntheticprecursor comprising nucleophilic groups with a second syntheticprecursor comprising electrophilic groups to form covalent crosslinks byreaction of the nucleophilic groups with the electrophilic groups toform the hydrogel. 68. The stent of 67 wherein the precursor is watersoluble. 69. The stent of any of 52-68 with the stent comprising atherapeutic agent, wherein the therapeutic agent is selected from thegroup consisting of dexamethasone, nifedipine, a steroid, an inhibitorof vascular endothelial growth factor, an antiangiogenesis agent, asmall molecule drug, a protein, a nucleic acid, and a growth factor. 70.The stent of any of 52-69 with the stent comprising a therapeutic agent,wherein the therapeutic agent is released over a period of time that isat least about three days. 71. The stent of any of 52-69 comprising atherapeutic agent, wherein a point at which a cumulative 80% w/w of thetherapeutic agent has been released is reached at a time between about14 days and 9 months. Artisans will immediately appreciate that allranges and values between the explicitly stated bounds are contemplated,with, e.g., any of the following being available as an upper or lowerlimit: 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, weeks, 1, 2, 3, 4, 5, 6, 7,8, 9 months. 72. A use of the stent of any of 52-71 as a stent for ananatomical lumen. 73. A use of the stent of 72 wherein the lumen is thatof a ureter, blood vessel, vein, artery, aorta, an aneurysm, a brainaneurysm, an abdominal aortic aneurysm, or a cardiac blood vessel. 74. Ause of the stent of 72 or 73 for a treatment of a stenosis or restenosisof veins, arteries, or a vascular structure; for urethral stenosis ofbenign prostate hyperplasia or a (benign or malignant) stricture of anesophagus; or for a bile duct occlusion. 75. A use of the stent 72 forstenting (in) a bowel wall, for instance, in inflammatory bowel diseaseor Crohn's disease, for one or more segments within the bowel that are,e.g., ulcerated and/or in need of treatment.

The invention claimed is:
 1. A method of treating a luminal pathologyaffecting an anatomical lumen of a patient comprising injecting aprecursor into a luminal wall of the anatomical lumen, and inflating aballoon in the anatomical lumen to expand the walls of the anatomicallumen, with the precursor reacting to form, in situ, a covalentlycrosslinked hydrogel stent within a luminal wall of the anatomical lumenwith the hydrogel stent placed so that the hydrogel is free of contactwith any fluids carried by the lumen.
 2. The method of claim 1 whereinthe precursor is in aqueous solution during the injecting into theluminal wall.
 3. The method of claim 1 wherein the stent comprises atherapeutic agent that is released from the stent.
 4. The method ofclaim 1 wherein the stent is biodegradable.
 5. The method of claim 1wherein the pathology is a stenosis or an aneurysm.
 6. The method ofclaim 1 wherein the luminal wall is that of a blood vessel, ureter,vein, artery, aorta, bile duct, intestine, part of a gastrointestinaltract, esophagus, lymph duct, an aneurysm, a brain aneurysm, anabdominal aortic aneurysm, or a cardiac blood vessel, or a peripheralblood vessel.
 7. The method of claim 1 wherein the luminal wall is thatof a urethra, with the pathology being benign prostate hyperplasia. 8.The method of claim 1 further comprising injecting a free radicalinitiator with the precursor, with the initiator initiatingpolymerization of the precursor to form the hydrogel stent.
 9. Themethod of claim 8 wherein the free radical initiator is thermal,photoactivatable, or a reduction-oxidation initiator.
 10. The method ofclaim 8 wherein the free radical initiator is a thermal initiator thatcomprises a 4, 4′ azobis (4-cyanopentanoic acid) group, a benzoylperoxide group, or an analog of a benzoyl peroxide group.
 11. The methodof claim 8 wherein the free radical initiator comprises a peroxide groupor a hydroperoxide group.
 12. The method of claim 8 wherein the freeradical initiator is a low temperature free radical initiator.
 13. Themethod of claim 1 comprising an injection device for the injection, thedevice comprising a balloon catheter, a spiral tube, or a wovenexpandable tube, said device further comprising an injection port forexpelling the one precursor from the device into the luminal wall. 14.The method of claim 13 wherein the device further comprising a resilientcurved needle and a pushing mandrel.
 15. The method of claim 13 whereinthe injection port is a hole.
 16. The method of claim 1 comprising aninjection device for the injection, the device comprising a plurality ofneedles for the injecting.
 17. The method of claim 1 wherein the stentbeing disposed within the luminal wall and also being disposed outsideof the walls of the lumen.
 18. The method of claim 1 wherein the stentis water degradable.
 19. The method of claim 1 wherein the precursor isa first precursor that comprises an electrophilic functional group andfurther comprising injecting a second precursor comprising anucleophilic group, wherein the hydrogel stent is a reaction product ofan electrophilic-nucleophilic reaction between electrophilic functionalgroups of the first precursor and nucleophilic functional groups of thesecond precursor.
 20. The method of claim 1 wherein the precursor is ahydrophilic polymer.
 21. The method of claim 20 wherein the precursorcomprises polyethylene glycol.
 22. The method of claim 1 wherein theprecursor is a free radical polymerizable polymer.
 23. The method ofclaim 1 wherein the precursor is a first precursor and furthercomprising injecting a second precursor with the first precursor,wherein the second precursor is a hydrophilic molecule, with the firstprecursor and the second precursor covalently crosslinking to form thecovalently crosslinked hydrogel stent.